Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 12775 | TX |
NPI | 1124417381 |
---|---|
Provider Name | Dr. Dan Noffsinger |
First Address | Austin, TX 78746-1128 |
Second Address | Austin, TX 78746-1128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2015 |
Last Update Date | 12/01/2015 |